Incidence and predictors of acute kidney injury in birth asphyxia in a Tertiary Care Hospital

Abstract

Objective: The objective of this study is to estimate the incidence of acute kidney injury (AKI) in birth asphyxia and to find out the predictors of AKI in birth asphyxia in a tertiary care hospital. Materials and Methods: This is a cross-sectional study conducted in the neonatal intensive care unit of a tertiary care center in Northern India during November 2014– October 2015. Inborn babies admitted here with severe birth asphyxia were included in the study. The neonates were evaluated for the evidence of AKI and were grouped into two groups: Group I (all neonates with severe birth asphyxia as per the WHO definition and having evidence of AKI) and Group II (all neonates with severe birth asphyxia as per the WHO definition and without having evidence of AKI). Those with congenital renal anomalies were excluded from the study. The two groups were then compared. AKI network definition was used to define AKI. Results: The incidence of AKI in the present study was 44.21%. There was no significant difference in incidence between term and preterm neonates, and among various stages of hypoxic-ischemic encephalopathy. The majority (95%) had nonoliguric renal failure. Most (92.8%) of the cases recovered before discharge and the rest recovered at 1 month follow-up. Prolonged labor was found to be significantly associated with AKI. Patients with shock had more advanced stages of AKI compared to those without shock. Conclusion: From this study, it can be inferred that it is difficult to predict AKI based on clinical features such as oliguria or Apgar score, and it is better to screen all the birth asphyxia cases for AKI so that they can be detected early and managed accordingly. In addition, a single normal value of blood urea/serum creatinine cannot exclude AKI, and serial monitoring is important. Shock should be detected early and treated aggressively as shock was associated with advanced stages of AKI.